


Case Notes for Initial Counseling Session: Anathema Device

by Euny_Sloane



Category: Good Omens (TV), Good Omens - Neil Gaiman & Terry Pratchett
Genre: Anathema is so sensible, Case Notes, Counseling, F/F, F/M, Mental Health Issues, Multi, Nonbinary, Other, Psychotherapy, queer, reference to anxiety, reference to bereavement, reference to biphobia, reference to grief, reference to nightmares, reference to queer microaggression, wlw
Language: English
Status: Completed
Published: 2019-08-30
Updated: 2019-08-30
Packaged: 2020-09-30 18:27:49
Rating: Teen And Up Audiences
Warnings: No Archive Warnings Apply
Chapters: 1
Words: 710
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/20451599
Author URL: https://archiveofourown.org/users/Euny_Sloane/pseuds/Euny_Sloane
Summary: An unnamed therapist has written clinical/case/therapy notes about an initial session with Anathema Device, who has gone to therapy on, well, someone's suggestion.  You'll just have to guess. She is eminently sensible, even if her boyfriend isn't and some of her friends are showing their biases.





	Case Notes for Initial Counseling Session: Anathema Device

**Subjective  
**Client explained that she is seeking counseling because she recently started a new relationship, noting that it was unexpected by her but predicted by a much older family member who is “gone now.” Client did not clarify the meaning of “gone,” but it sounds as if her family member has died. Client is also making some changes in her career which she worries about rushing into without help. She explained that she has always relied on the aforementioned family member to guide her decisions but faces them on her own now and the uncertainty is difficult to tolerate. 

Client hopes that taking time to air her concerns in a nonjudgmental space will help her to navigate the changes she is experiencing. She also prefers to get concrete advice for new coping skills, rather than “nattering on” about her childhood. Client observed “I can’t just keep breaking pots whenever I get upset. It’s becoming expensive.” 

Client says she is also having some sleep difficulties. She reports experiencing especially troubling nightmares during which people ask her important questions and she turns to find a book with the answers, only it is several years out of date, or unavailable, or turns out to be Goodnight, Moon. On the worst nights, her failure to find answers in the dream is followed by hearing a huffy sigh behind her and turning around to see a woman wearing 17th century clothing and an exasperated expression, at which point she invariably wakes up.

Client identifies as queer, finding “restrictive identity labels” to be "just another conspiracy by those in power to control us,” although is comfortable with she/her pronouns. Client is, however, struggling with her new relationship, as most of her intimate relationship history has been with women and nonbinary individuals. 

Client denies any internal difficulty with this change in pattern, but she is having trouble with some of her friends critiquing not just her particular choice in boyfriend, N., but also questioning her identity as a queer woman. Client noted that she thinks they are trying to joke about it, but it feels invalidating and alienating anyway. Client observed that her closest friends are not exhibiting this particular behavior and although they think N. is “a bit of a twit,” they see how happy she is with him and appreciate that he fully accepts her without trying to control her life in any way, “which is awfully novel.” 

**Objective  
** Client is a 20 year old woman with a doctoral degree in the historical representation of women. She was dressed appropriately for the weather in a long-sleeved dress and boots and wore large glasses. She made reference to several conspiracy theories but otherwise appears to have no abnormal perceptions or beliefs. Client made very direct eye contact, laughed easily, and only appeared anxious or distressed when discussing her friends’ microaggressions with regard to her queer identity. Client fiddled with her jewelry when discussing distressing content and otherwise appeared calm and confident. Client polite, engaged and forthcoming throughout session. 

**Assessment and Plan  
** Discussed current level of functioning in multiple life domains. Discussed client’s expectations for counseling. Session topics largely guided by client; she seems highly motivated to make good use of our visits and has already scheduled follow up. 

Repetitive nature of client’s dreams is somewhat suggestive of trauma, which may be worth exploring. Regardless, repetitiveness also might lend itself to treatment via dream imagery rehearsal and retelling techniques. Client appears to be comfortable with reading and writing, so journaling techniques may be appropriate. 

Will need to further explore ct’s family history and family relationships, especially in the context of bereavement; may explore or introduce tasks of mourning, particularly how to create new ways to connect with her family member.    
  


**Diagnosis**   
F43.22 Adjustment disorder with anxiety  
Z56.1 Problems related to employment: change of job  
Z63.4: Bereavement

**Additional  
** When asked about referral source, client indicated that she had had one last piece of advice from her lost family member, so knew we would get on well, although she also rolled her eyes and noted that she was perfectly capable of finding a therapist on her own. Then she smiled broadly, as if at a shared joke, though no joke was apparent to this writer. 

**Author's Note:**

> I wrote one of these for Crowley, honestly expecting all of one other human being to read it and many people have and it is so goddamn exciting. I have no idea what's supposed to go in this notes section but I'm going to fill it with stunned gratitude and excitement and a comment that I plan to write more of these, though for some reason writing one for Death sounds easier than writing one for Aziraphale. 
> 
> On the notes for Crowley, several folk asked if this is realistic and normal for clinical/psychotherapy/counseling case notes and the answer is - mostly. Clinical notes are meant to be written quickly, not to be funny or warm, and to capture only the essentials of the session. I would probably make any intern who gave me this note for Anathema cut down the subjective section by at least half. Also everyone writes case notes a little differently, depending on training, temperament, writing voice, and requirements of their setting, though the Subjective/Objective/Assessment/Plan sections are nearly sacrosanct and the practice of referring to the client by "client" or "patient" rather than writing their name is the norm, as is referring (if at all) to the therapist/counselor in the third person. Similarly, individuals not in the therapy session are usually referred to by initials, though gods help me I don't know why.


End file.
